M. Mourikhttp://repub.eur.nl/ppl/11889/
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RePub, Erasmus University RepositoryGlutamine supplementation of parenteral nutrition does not improve intestinal permeability, nitrogen balance, or outcome in newborns and infants undergoing digestive-tract surgery: results from a double-blind, randomized, controlled trialhttp://repub.eur.nl/pub/10379/
Sat, 01 Jan 2005 00:00:01 GMT<div>E.W. Steyerberg</div><div>F.W.J. Hazebroek</div><div>M. Mourik</div><div>G.J.J.M. Borsboom</div><div>T. Rietveld</div><div>J.G.M. Huijmans</div><div>D. Tibboel</div><div>M.J.I.J. Albers</div>
OBJECTIVE: To assess the effect of isocaloric isonitrogenous parenteral
glutamine supplementation on intestinal permeability and nitrogen loss in
newborns and infants after major digestive-tract surgery. SUMMARY
BACKGROUND DATA: Glutamine supplementation in critically ill and surgical
adults may normalize intestinal permeability, attenuate nitrogen loss,
improve survival, and lower the incidence of nosocomial infections.
Previous studies in critically ill children were limited to
very-low-birthweight infants and had equivocal results. METHODS: Eighty
newborns and infants were included in a double-blind, randomized trial
comparing standard parenteral nutrition (sPN; n = 39) to
glutamine-supplemented parenteral nutrition (GlnPN; glutamine target
intake, 0.4 g kg day; n = 41), starting on day 2 after major
digestive-tract surgery. Primary endpoints were intestinal permeability,
as assessed by the urinary excretion ratio of lactulose and rhamnose
(weeks 1 through 4); nitrogen balance (days 4 through 6), and urinary
3-methylhistidine excretion (day 5). Secondary endpoints were mortality,
length of stay in the ICU and the hospital, number of septic episodes, and
usage of antibiotics and ICU resources. RESULTS: Glutamine intake
plateaued at 90% of the target on day 4. No differences were found between
patients assigned sPN and patients assigned GlnPN regarding any of the
endpoints. Glutamine supplementation was not associated with adverse
effects. CONCLUSIONS: In newborns and infants after major digestive-tract
surgery, we did not identify beneficial effects of isonitrogenous,
isocaloric glutamine supplementation of parenteral nutrition. Glutamine
supplementation in these patients therefore is not warranted until further
research proves otherwise.